Myeloma

Question 1

What are the five types of heavy chains?

Answer 1

• Gamma: IgG
• Alpha: IgA
• Mu: IgM
• Delta: IgD
• Epsilon: IgE

Question 2

What are the functions of the different heavy chains?

Answer 2

• IgM: initial phase of antibody production
• IgG: most prevalent antibody subclass
• IgA: mucous membrane immunity
• IgE: parasite immune responses and hypersensitivity

Question 3

What are the two types of light chains?

Answer 3

• Kappa

- Lambda

Question 4

What is a paraprotein and what does it tell you?

Answer 4

• Monoclonal immunoglobulin present in the blood or urine

- Its presence tells us that there is monoclonal proliferation of a B lymphocyte/plasma cell somewhere in the body

Question 5

How can paraproteins be detected?

Answer 5

-Serum protein electropheresis

Question 6

What other tests can detect immunoglobulins?

Answer 6

• Total immunoglobulin levels
• Immunofixation: identifies what class of paraprotein is present e.g. IgF
• Light chains: assesses imbalance/excess of light chains in the urine/serum

Question 7

Where are the the different antibodies made?

Answer 7

• IgM is made in the lymph node

- IgG and IgA are made in the bone marrow

Question 8

Which antibodies are involved in myeloma?

Answer 8

IgG and IgA paraproteins

Question 9

How does myeloma present?

Answer 9

• 7th decade
• Commoner in black population
• Bone disease: lytic bone lesions, pathological fractures, cord compression and hypercalcaemia
• Bone marrow failure esp. anaemia
• Infections
• Renal failure

Question 10

What effects can the paraprotein have on the body?

Answer 10

• Renal failure: immunoglobulin deposition
• Hyperviscosity
• Hypogammaglobulinaemia

Question 11

What is amyloidosis?

Answer 11

A group of diseases characterised by deposition of fibrillar protein

Question 12

Name examples of conditions caused by amyloidosis

Answer 12

• Nephrotic syndrome
• Cardiac failure
• Carpal tunnel syndrome
• Autonomic neuropathy
• Cutaneous infiltration

Question 13

What is the name given to paraproteins that are not due to a disease but are normal?

Answer 13

Monoclonal gammopathy of uncertain significance (MGUS)

Question 14

What is the most common type of paraprotein found in myeloma?

Answer 14

IgG

Question 15

How can myeloma be staged?

Answer 15

• Albumin

- Beta-2 microglobulin

Question 16

How can myeloma be treated?

Answer 16

• Chemotherapy (proteasome inhibitors, IMiDs and monoclonal antibodies)
• Bisphosphonate therapy
• Radiotherapy
• Steroids
• Surgery
• Autologous stem cell transplant